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AetnaCommercial · Coverage · Pharmacy · Ophthalmology, Vascular SurgeryMedium impact

Novel Injection Methods (CPB 0777, reviewed 2025-12-02)

Effective date
Not stated in the notice
Identified
Aug 17, 2026
Replaced. This version was replaced by Novel Injection Methods (CPB 0777, reviewed 2026-10-27) (published Oct 27, 2026).

Summary

Aetna considers suprachoroidal injection of triamcinolone acetonide injectable suspension (Xipere) medically necessary for macular edema associated with uveitis when the criteria in CPB 1000 are met. Aetna considers suprachoroidal injection of all other pharmacologic agents experimental, investigational or unproven for all indications, and considers sub-retinal injection of recombinant tissue plasminogen activator (rtPA) for the treatment of sub-macular hemorrhage medically necessary. The Mercator Bullfrog micro-infusion device is considered experimental, investigational or unproven for direct adventitial delivery of diagnostic or therapeutic agents via blood vessel walls.

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What to do

Action · 4 steps
01Billing team: Bill suprachoroidal injection of Xipere (CPT 67516 with HCPCS J3299, 1 mg) with ICD-10 H35.81 (retinal edema) only for macular edema associated with uveitis when the criteria in CPB 1000 are met.
02Do not schedule or bill suprachoroidal injection of any other pharmacologic agent, because CPT 67516 and CPT 0699T are not covered for the indications listed in the policy and Aetna considers suprachoroidal delivery of all other agents experimental, investigational or unproven for all indications.
03Bill sub-retinal injection of rtPA with CPT 0810T for sub-macular hemorrhage, using the ICD-10 retinal hemorrhage codes H35.60 through H35.63.
04Do not bill HCPCS C9759 for the Mercator Bullfrog micro-infusion device, because it is not covered for direct adventitial delivery and Aetna considers that use experimental, investigational or unproven.

Codes mentioned

67516J3299C9759H35.81

Original notice

Novel Injection Methods (CPB 0777, reviewed 2025-12-02)
aetna.com · Always check the source before changing claims.
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Related changes

See all Aetna changes →
Novel Injection Methods (CPB 0777, reviewed 2026-10-27)MediumNo effective date · PharmacyTriamcinolone Acetonide Injectable Suspension (Xipere) (CPB 1000, reviewed 2026-04-24)MediumEffective Feb 22, 2022 · Medical PolicyTranspupillary Thermal Therapy (CPB 0490, reviewed 2026-10-05)MediumNo effective date · Medical PolicyDexamethasone Ophthalmic Implant (Ozurdex) and Insert (Dextenza) (CPB 0795, reviewed 2026-10-05)MediumNo effective date · SurgeryBrowse every Aetna change in the policy list

Related policy hubs

Aetna policiesOphthalmologyVascular SurgeryCode 67516Code J3299Code C9759Code H35.81

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